Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Coronal and Sagittal Plane Correction in Adolescent Idiopathic Scoliosis: A Comparison Between All Pedicle Screw Versus Hybrid Thoracic Hook Lumbar Screw Constructs

Lowenstein, Jason E., MD*; Matsumoto, Hiroko, MA*†‡; Vitale, Michael G., MD, MPH*†‡; Weidenbaum, Mark, MD*; Gomez, Jaime A., MD; Lee, Francis Young-In, MD, PhD*†; Hyman, Joshua E., MD*†; Roye, David P. Jr, MD*†

doi: 10.1097/01.brs.0000255030.78293.fd
Deformity
Buy

Study Design. This was a retrospective cohort study using a previously matched convenience sample of 34 patients.

Objective. This study sought to determine the relative corrective benefits of these 2 types of constructs in the correction of coronal and sagittal curves in patients with adolescent idiopathic scoliosis (AIS). In addition, the 2 constructs were compared for coronal and sagittal balance.

Summary of Background Information. Recent clinical research suggests that thoracic pedicle screw constructs (all-screw constructs) are more effective than hybrid lumbar screw thoracic hook constructs (hybrid constructs) in correcting spine deformity.

Methods. The sample consisted of patients with AIS who underwent isolated posterior spinal fusion and instrumentation. Seventeen patients underwent fusion using all-screw constructs, and 17 underwent fusion with hybrid constructs; preoperative and postoperative radiographs and measurements were compared.

Results. There was no significant difference observed when comparing the 2 groups, although there was a trend toward better correction of the main thoracic curve in the all-screw construct group (P = 0.089). In the all-screw group, mean thoracic kyphosis decreased from 29.6° to 19.4° (P = 0.012). Sagittal balance changed in the hybrid group from −21.2 mm to 8.2 mm, and in the all-screw group changed from −28.8 mm to 1.5 mm. The major curve in the hybrid group improved from 54.06° to 20.25° and improved from 54.88° to 15.06° in the all-screw group.

Conclusions. There was no statistically significant difference comparing the 2 groups, although a trend was observed toward better correction of the main thoracic curve in the all-screw construct group. The all-screw group demonstrated a significant decrease in kyphosis, which was not seen in the hybrid group. Hybrid constructs were comparable to all-screw constructs in the correction of coronal plane deformity and sagittal balance.

The all-screw constructs and the hybrid constructs offered similar coronal and sagittal correction in patients with adolescent idiopathic scoliosis, although there was a trend toward better correction of thoracic curve in the all-screw group. The all-screw group demonstrated a significant decrease in kyphosis, which was not seen in the hybrid group.

From the *Morgan Stanley Children’s Hospital of New York Presbyterian, Columbia University Medical Center, New York, NY; †Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, New York, NY; and ‡International Center for Health Outcomes and Innovation Research, Columbia University College of Physicians and Surgeons, and the Joseph L. Mailman School of Public Health, New York, NY.

Acknowledgment date: January 31, 2006. First revision date: April 13, 2006. Acceptance date: June 10, 2006.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to David P. Roye, Jr., MD, 600 West 168th Street, 7th Floor, New York, NY 10032; E-mail: dpr2@columbia.edu

© 2007 Lippincott Williams & Wilkins, Inc.